Organization
INDIAN RIVER RESIDENTIAL CARE COMMUNITY
Active
Other names
dba Indian River Retirement Community, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
GUY S PIERCE (MANAGING MEMBER)
(336) 595-1075
Entity
Organization
Contact information
Practice address
1012 JUSTIS ST, CHESAPEAKE, VA 23325-2516
(757) 523-4659
Mailing address
PO BOX 1487, KERNERSVILLE, NC 27285-1487
(336) 595-1075
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5002281
—
VA
Enumeration date
11/28/2006
Last updated
08/22/2020
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